María José Cabañero-Martínez PhD, Assistant Professor in the Department of Nursing, Faculty of Health Sciences, University of Alicante, Spain, explains the background to her longer article selected as Editor’s Choice in the June edition of Palliative Medicine.

“For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink . . .” (Matthew 25:35)

María José Cabañero-Martínez

The management of the hydration of patients at their end-of-life stage is one of the dilemmas that health professionals face daily in clinical practice. What leads a professional team to make the decision either to hydrate or not a patient at the end of his/her life? Is it ethical to either withdraw or not to hydrate a patient? Is it considered as a minimum standard of care? When we’re hydrating, are we extending the suffering of these patients? Which is the best method of hydration for these patients?

These are some of the questions that the members of our research group were considering when we decided to start working on a project about the use of subcutaneous hydration in palliative patients in Spain. At that time, the literature did not clarify any of our questions and, according to the latest reviews, we could not say that hydration was the best option to control the symptoms. Some studies demonstrated that it could improve some symptoms, though at the same time it could worsen others. In relation to which technique of hydration is the most appropriate when the patient cannot drink, the results published indicate that subcutaneous hydration is as safe and effective as intravenous hydration to control mild to moderate dehydration. However, experience and observation tell us that it was not used even when it could be pertinent to do so. So what is happening?

Faculty of Health Sciences, University of Alicante, Spain

As experienced researchers, we went to the primary source and talked to professionals who work directly with palliative patients in our context. From data collected from focus groups (and survey results that we are currently analysing), we have observed that all the outcomes follow the same trend. The decisions that health professionals make are not as objective as we think as they are influenced by several factors, such as the care setting, the specialisation of professionals, their beliefs and experiences. The influence of these factors determines that there is a high uncertainty about the technique or the decision to take, due to the absence, or ignorance, of published evidence.

The uncertainty about the benefits of whether or not to hydrate patients at end-of-life seems to influence the final use of subcutaneous hydration, as it will affect both the perceptions of professionals and the justification of the family’s request for hydration. Despite the difficulties of the development of controlled studies in the field of palliative care, it is necessary to obtain evidence to support the development of clinical pathways, decision-making algorithms and protocols in order to unify the available evidence, facilitate decision-making and reduce uncertainty.

AcknowledgementThis project has been co-funded by a grant from the Institute of Health Carlos III (PI10/00847) of the Ministry of Economy and Competitiveness (Spain) and the European Regional Development Fund (FEDER).

How to download previously published ‘Editor’s choice’ articlesAs Palliative Medicine is the official research journal of the EAPC, we are delighted to offer EAPC members and registered users of our website free access to ‘Editor’s choice’ articles. To download previously published papers, you may need to register or login first. Please follow the instructions in the top right-hand corner of the EAPC home page and scroll down to the article. Click here to view other EAPC-originated papers.